Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

Abstract Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

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Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

10.21203/rs.2.23235/v3 ◽

2020 ◽

Author(s):

Nicole Etherington ◽

Isabel Braganca Rodrigues ◽

Lora Giangregorio ◽

Ian D. Graham ◽

Alison M Hoens ◽

...

Keyword(s):

Theoretical Domains Framework ◽

Implementation Process ◽

Barriers And Facilitators ◽

Implementation Barriers ◽

Modified Delphi ◽

Delphi Approach ◽

Effective Interventions ◽

Novel Approach ◽

Interdisciplinary Framework ◽

Context Shapes

Abstract Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

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Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

10.21203/rs.2.23235/v2 ◽

2020 ◽

Author(s):

Nicole Etherington ◽

Isabel Braganca Rodrigues ◽

Lora Giangregorio ◽

Ian D. Graham ◽

Alison M Hoens ◽

...

Keyword(s):

Theoretical Domains Framework ◽

Implementation Process ◽

Barriers And Facilitators ◽

Implementation Barriers ◽

Modified Delphi ◽

Delphi Approach ◽

Effective Interventions ◽

Novel Approach ◽

Interdisciplinary Framework ◽

Context Shapes

Abstract Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

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Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

10.21203/rs.2.23235/v1 ◽

2020 ◽

Author(s):

Nicole Etherington ◽

Isabel Braganca Rodrigues ◽

Lora Giangregorio ◽

Ian D. Graham ◽

Alison M Hoens ◽

...

Keyword(s):

Majority Vote ◽

Theoretical Domains Framework ◽

Implementation Process ◽

Social Identities ◽

Implementation Barriers ◽

Modified Delphi ◽

Delphi Approach ◽

Novel Approach ◽

Interdisciplinary Framework ◽

Context Shapes

Abstract Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors and structures of power, offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. The modified Delphi involved two rounds of online voting followed by a final majority vote. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. By considering the role of intersecting social factors when selecting, tailoring, and implementing KT interventions, they may become more effective.

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Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

10.21203/rs.2.21766/v1 ◽

2020 ◽

Author(s):

Nicole Etherington ◽

Isabel Braganca Rodrigues ◽

Lora Giangregorio ◽

Ian D. Graham ◽

Alison M Hoens ◽

...

Keyword(s):

Majority Vote ◽

Theoretical Domains Framework ◽

Implementation Process ◽

Social Identities ◽

Implementation Barriers ◽

Modified Delphi ◽

Delphi Approach ◽

Novel Approach ◽

Interdisciplinary Framework ◽

Context Shapes

Abstract Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors and structures of power, offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. The modified Delphi involved two rounds of online voting followed by a final majority vote. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. By considering the role of intersecting social factors when selecting, tailoring, and implementing KT interventions, they may become more effective.

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Exemplars Illustrating De-implementation of Tradition-Based Practices

Critical Care Nurse ◽

10.4037/ccn2019534 ◽

2019 ◽

Vol 39 (6) ◽

pp. 64-69 ◽

Cited By ~ 1

Author(s):

Michele J. Upvall ◽

Annette M. Bourgault ◽

Cody Pigon ◽

Christine A. Swartzman

Keyword(s):

Internal Medicine ◽

Critical Care ◽

Clinical Practice ◽

Cognitive Dissonance ◽

Implementation Process ◽

Barriers And Facilitators ◽

Evidence Based ◽

Implementation Barriers ◽

Complex Process ◽

Psychological Bias

Clinical practice must be based on evidence. When evidence suggests that a certain practice may be ineffective or even harmful, that practice should be discontinued. The Choosing Wisely campaign, an initiative of the ABIM (American Board of Internal Medicine) Foundation, is intended to bring attention to tradition-based practices, or “sacred cows,” which lack evidence to support their ongoing use. The complex process of discontinuing or reducing the use of tradition-based practices is known as “de-implementation.” Recognizing the importance of de-implementation is necessary to fully understand evidence-based practice. This article explores the de-implementation process, examining its barriers and facilitators. Three critical care exemplars of tradition-based practices are presented and examined through the lens of de-implementation. Barriers and facilitators related to de-implementing these tradition-based practices are described, with an emphasis on the roles of various stakeholders and the need to overcome cognitive dissonance and psychological bias.

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Implementing a toolkit for the prevention, management and control of carbapenemase-producing Enterobacteriaceae in English acute hospitals trusts: a qualitative evaluation

BMC Health Services Research ◽

10.1186/s12913-019-4492-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Annegret Schneider ◽

Caroline Coope ◽

Susan Michie ◽

Richard Puleston ◽

Susan Hopkins ◽

...

Keyword(s):

Theoretical Domains Framework ◽

Qualitative Evaluation ◽

Hospital Staff ◽

Barriers And Facilitators ◽

Infection Prevention And Control ◽

Implementation Barriers ◽

Level Of Evidence ◽

Frontline Staff ◽

Acute Hospitals ◽

And Control

Abstract Background Antimicrobial resistance is an increasing problem in hospitals world-wide. Following other countries, English hospitals experienced outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a bacterial infection commonly resistant to last resort antibiotics. One way to improve CPE prevention, management and control is the production of guidelines, such as the CPE toolkit published by Public Health England in December 2013. The aim of this research was to investigate the implementation of the CPE toolkit and to identify barriers and facilitators to inform future policies. Methods Acute hospital trusts (N = 12) were purposively sampled based on their self-assessed CPE colonisation rates and time point of introducing local CPE action plans. Following maximum variation sampling, 44 interviews with hospital staff were conducted between April and August 2017 using a semi-structured topic guide based on the Capability, Opportunity, Motivation and Behaviour Model and the Theoretical Domains Framework, covering areas of influences on behaviour. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results The national CPE toolkit was widely disseminated within infection prevention and control teams (IPCT), but awareness was rare among other hospital staff. Local plans, developed by IPCTs referring to the CPE toolkit while considering local circumstances, were in place in all hospitals. Implementation barriers included: shortage of isolation facilities for CPE patients, time pressures, and competing demands. Facilitators were within hospital and across-hospital collaborations and knowledge sharing, availability of dedicated IPCTs, leadership support and prioritisation of CPE as an important concern. Participants using the CPE toolkit had mixed views, appreciating its readability and clarity about patient management, but voicing concerns about the lack of transparency on the level of evidence and the practicality of implementation. They recommended regular updates, additional clarifications, tailored information and implementation guidance. Conclusions There were problems with the awareness and implementation of the CPE toolkit and frontline staff saw room for improvement, identifying implementation barriers and facilitators. An updated CPE toolkit version should provide comprehensive and instructive guidance on evidence-based CPE prevention, management and control procedures and their implementation in a modular format with sections tailored to hospitals’ CPE status and to different staff groups.

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Important implementation constructs for federal agencies in health and human service settings that are selecting, monitoring, and supporting grantees

Evidence & Policy A Journal of Research Debate and Practice ◽

10.1332/174426418x15409834211096 ◽

2020 ◽

Vol 16 (3) ◽

pp. 375-392

Author(s):

Allison Dymnicki ◽

Robin Bzura ◽

David Osher ◽

Abraham Wandersman ◽

Dan Duplantier ◽

...

Keyword(s):

Literature Review ◽

Human Service ◽

Implementation Process ◽

Science Research ◽

Federal Agencies ◽

Routine Practice ◽

Successful Implementation ◽

Modified Delphi ◽

Delphi Approach ◽

Areas Of Interest

Background:Federal agencies and other funders seeking to maximise their impact aim to understand factors associated with implementing evidence-based interventions (EBIs) to address health problems. Challenges exist, however, in synthesising information from different disciplines and reaching agreement about these factors due to different terminology, frameworks, and measures being used in different fields. Methods:A mixed-methods approach was used to identifying a set of implementation constructs helpful for selecting, monitoring, and supporting federal grantees in health and human service settings. Three phases of research were conducted: a literature review, structured expert interviews, and consensus building. Interviews with implementation experts were used to validate a set of implementation constructs identified in the literature review as strongly and consistently related to successful implementation of EBIs in international contexts. A modified Delphi approach was used with a technical working group (TWG) of federal staff to agree on the constructs most relevant for federally funded EBIs. Findings:This process yielded 11 constructs related to either the intervention, the intersection between the invention and context, or the implementation process. These constructs are areas of interest when integrating research evidence into routine practice. Expert interviewees recommended establishing clear, consistent construct definitions before developing valid, feasible measures of the constructs. In contrast to the numerous and specific constructs advanced by researchers, federal TWG members favoured fewer constructs with more generalisability. Discussion and conclusions:This article demonstrates the translation work required for policy contexts and highlights a successful approach to translate evidence from implementation science research for federal staff.

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A Process Evaluation of San Francisco’s Law Enforcement Assisted Diversion Program

Criminal Justice Policy Review ◽

10.1177/08874034211033328 ◽

2021 ◽

pp. 088740342110333

Author(s):

Erica Jovanna Magaña ◽

Dina Perrone ◽

Aili Malm

Keyword(s):

Law Enforcement ◽

San Francisco ◽

Program Implementation ◽

Relationship Building ◽

Barriers And Facilitators ◽

Implementation Barriers ◽

Diversion Program ◽

Drug Laws ◽

Point Of Entry ◽

Reducing Recidivism

In 2016, San Francisco (SF) implemented the Law Enforcement Assisted Diversion (LEAD) program, a harm reduction–based pre-booking diversion system for people who violate drug laws and/or are engaged in sex work. LEAD is set apart from existing diversion programs, as it uses police as point of entry. Prior LEAD studies indicate some success in reducing recidivism and improving life outcomes. However, less is known about program implementation, including barriers and facilitators. Relying on policy documents, interviews, and focus groups, this study describes the LEAD SF’s development, operations, adaptations, and challenges. It also identifies the unique context of LEAD SF that led to implementation barriers and facilitators. Results show that SF experienced success in collaboration, relationship building, and client connections to services but experienced challenges in securing and maintaining police officer buy-in and keeping clear and open lines of communication regarding LEAD goals, objectives, policies, and procedures. This led to the termination of LEAD SF in 2020.

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A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.073 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 41-42

Author(s):

E Johnson ◽

M Carbonneau ◽

D Campbell-Scherer ◽

P Tandon ◽

A Hyde

Keyword(s):

Focus Groups ◽

Gastrointestinal Disease ◽

Pragmatic Trial ◽

Healthcare Providers ◽

Structured Interview ◽

Barriers And Facilitators ◽

Care Utilization ◽

Implementation Barriers ◽

Mortality And Morbidity ◽

Order Set

Abstract Background Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta. Aims As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation. Methods We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively. Results Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process. Conclusions Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites. Funding Agencies Alberta Innovates

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